Military Update

Stung by 'raw politics,' Roe assesses VA choice, caregiver plans

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Rep. Phil Roe, R-Tenn., chairman of the House Veterans Affairs Committee, expected on Tuesday that every committee member, Democrat and Republican, would vote for the VA Care in the Community Act (HR 4242), his comprehensive plan developed over months to reform the flawed Veterans Choice program.

Roe therefore said he was surprised and disappointed when all nine Democrats at the bill’s markup hearing opposed the legislation they helped to shape and for which they were original co-sponsors.

In a phone interview, Roe blamed the split vote on “pure, blatant, raw politics based on this tax bill.”

The tax bill in dispute is the Tax Cuts and Jobs Act backed solely by Republicans. Democrats and many independent analysts contend it overwhelmingly favors corporations and the wealthy over middle-class taxpayers. The Congressional Budget Office forecasts it will drive up the nation’s debt by $1.5 trillion in a decade.

Democrats told Roe they could not in principle vote for his Choice reform bill, given uncertain funding support ahead if many more veterans need outside care, and on the same day House Republicans alone approved a mammoth tax relief bill.

During markup of Roe’s bill, various amendments were accepted or rejected. But Democrats and Republicans also traded insults and challenged motives in a committee room where compliments over bipartisanship typically are exchanged.

“I am troubled that we are going to put Choice funding at risk, again, on the very day that some people on this committee will be voting to drive up deficits and to give a tax break to the wealthiest Americans,” said Rep. Ann Kuster, D-N.H.

Rep. Tim Walz (D-Minn.), ranking Democrat on the panel, said the Republican tax relief bill attacks Obamacare funding and Medicaid eligibility, so that more veterans from these populations might have to rely on VA for health care, increasing budget strain on VA-paid community care as reforms take hold.

What particularly upset Democrats, in the shadow of a massive tax relief bill, was an amendment Roe planned to offer at markup that would cap growth of authorized funding for VA-paid community health care at three percent annually for four straight years, starting in fiscal 2019.

Roe drafted his cap language after CBO’s cost estimate for his Choice reform bill came in at roughly $39 billion over five years, more than double what Roe expected. It alarmed Republicans negotiating the easing of spending caps on other federal departments, including for defense, to avoid a government shutdown.

Roe said he decided moments before markup to withdraw his amendment, at the urging of veteran service organizations who opposed it. He didn’t reveal his decision, however, until late in the hearing, after members had traded harsh words.

The Choice reform bill cleared committee on a straight 14-9 party-line vote. Many of its reforms are also proposed in the Caring for Our Veterans Act (S. 2193), approved by the Senate Veterans’ Affairs Committee three weeks earlier.

Veterans service organizations prefer the Senate bill, in part because it embraces another key goal, to expand eligibility for Post-9/11 caregiver benefits to older generations of veterans and caregivers. Some veteran groups are also nervous that Roe’s bill would allow veterans referred to community-based primary care providers to stay with them for a year or even longer. Guardians of the VA health care system worry this would be a step toward privatizing veterans’ care.

Roe, an obstetrician who ran a private practice for 31 years, said his intent is not to privatize veterans’ health care but, through competition, force improvement in care quality and management of staff and resources across VA’s 168 hospitals.

“I’ve said from the beginning [that] I most likely would have written more choice into the bill” if possible, he said, given how competition improved outcomes in his own practice.

The House and Senate are expected to debate and vote on their Choice reform bills in early 2018. Differences then will be resolved a House-Senate conference led by Roe and Sen. Johnny Isakson (R-Ga.), chairman of the Senate committee. In our interview, Roe said he probably will not support including Senate caregiver expansion language in a final Choice reform bill.

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